Complications after surface replacing and silicone PIP arthroplasty: an analysis of 703 implants

Cohort profile: the Schulthess registries in Zurich for hand implants and forearm corrective osteotomies

PURPOSE

Our hand and forearm registries were established to evaluate safety, function, quality of life and patient satisfaction in patients undergoing thumb and finger implant arthroplasties, as well as corrective osteotomy of the forearm with individual patient solution (IPS) implants.

PARTICIPANTS

Four registries were initiated between 2010 and 2020 and enrolled patients who underwent implant arthroplasties of the thumb carpometacarpal (CMC) joint (n = 486), proximal interphalangeal (PIP) or thumb interphalangeal (IP) joint (n = 864) and metacarpophalangeal (MCP) (n = 34) joint, as well as 27 patients who underwent corrective osteotomy of the distal radius or forearm using an IPS implant. All patients complete disease-specific questionnaires and undergo clinical assessment before surgery (baseline) and up to 10 years thereafter.

FINDINGS TO DATE

All operated patients (100%) were included in the registries with complete baseline data. One-year follow-up rates ranged from 59% to 95% and 5-year follow-up ranged from 48% to 83%. Data completeness rates (ie, the number of cases with available data divided by the expected number of cases) ranged from 66% to 96% for the 1-year follow-up and 60% to 89% for the 5-year follow-up. Patients showed significantly improved postoperative clinical and patient-reported outcomes compared with baseline. The registries serve as a basis for standardised patient monitoring, quality control and answering several clinical questions. With the help of these large databases, clinical practice can be improved for the benefit of our patients.

FUTURE PLANS

As the first patients approach the 10-year follow-up landmark, the registry will continue to provide essential data on long-term clinical and patient-reported outcomes, as well as revision rates. In addition to research and quality control, cohort data will be used to enhance real-time clinical decision-making for patients.

Proximal interphalangeal joint arthroplasty using self-locking type surface replacement implant for symptomatic osteoarthritis: Extended dorsal central splitting approach and intermediate-term outcome

BACKGROUND

This retrospective study introduced wide exposure and radical osteophytectomy by employing the extended dorsal central splitting approach (EDCSA) to mitigate complications associated with surface implant arthroplasty for osteoarthritis of the proximal interphalangeal (PIP) joint using a self-locking type of implant.

METHODS

In total, 171 fingers of 113 patients underwent cementless surface non-constrained PIP implantation using the EDCSA. The surgical approach involved larger implant placement, optional procedures, and complex collateral ligament repair following wide exposure and thorough shaving of the osteophytes and periarticular bone. Pre- and postoperative outcomes; range of motion; Quick Disabilities of the Arm, Shoulder, and Hand (Q-DASH) scores; subjective pain scores; radiographic findings; and patient satisfaction were assessed.

RESULTS

The active range of motion of the PIP joint improved from -18°/58° to -15°/84° (extension/flexion), and remaining stiffness (arc < 40°) was observed in 21 PIP joints (12%) at a mean follow-up of 4.8 years. Patients reported significantly reduced pain and improved Q-DASH scores, with 92% overall patient satisfaction. Radical osteophytectomy effectively prevented recurrence and heterotopic ossification. Complications in the operated fingers occurred in 24.0% of cases, with a reoperation rate of 8.8%, primarily due to soft tissue-related issues. No implant-related symptomatic complications were identified, except for 1 case of dislocation and 1 of mild implant loosening with infection.

CONCLUSION

Self-locking surface replacement implants offer stable fixation without failure in the intermediate term. The EDCSA demonstrated excellent results and advantages, leading to easy identification of each joint structure to facilitate radical osteophytectomy.

Proximal interphalangeal joint arthroplasty: current trends and evidence-based practice

Arthroplasty of the proximal interphalangeal joint (PIPJ) has evolved since its inception over 60 years ago. This review examines the indications for surgery, highlights the differences in current arthroplasty designs, variances in surgical techniques, clinical controversies, current implant outcomes data and salvage options for the failed implant. Overall, PIPJ implant arthroplasty is a good and reliable option for symptomatic PIPJ degenerative, post-traumatic or inflammatory arthritis given the proper clinical setting. If current techniques for implantation and rehabilitation are followed, predictable pain relief and satisfactory function can be anticipated. The purpose of this review article is to examine the current evidence-based indications for PIPJ arthroplasty and examine the reported, implant-specific outcomes of this procedure. Various techniques and rehabilitation strategies will also be outlined.

Utilization of Interphalangeal Joint Arthroplasty and Arthrodesis in the United States From 2010 to 2019

Background

Interphalangeal joint (IPJ) arthrodesis and arthroplasty are mainstay treatments for IPJ arthritis with conflicting evidence about the most efficacious choice. Our study describes case volume and incidence over the last decade (2010-2019).

Methods

The IBM MarketScan database was queried using Current Procedural Terminology codes for IPJ arthrodesis and arthroplasty from January 2010 to December 2019. Volume and incidence were estimated annually and according to sex, age, and US geographical region for 2010 and 2019.

Results

Annual volume and incidence of IPJ arthrodesis increased slightly from 2010 to 2019, though with overlapping confidence intervals for incidence. Arthrodesis tended to be higher in women versus men, especially with increasing age. When considering age, the most substantial increase in rates over increasing age was moving from the 40s to 50s age brackets. Across US regions, arthrodesis was higher in the northeast and midwest in 2010, though other rates rose and regions were similar by 2019. For IPJ arthroplasty, there was a 25%-30% decrease in case volume and incidence over the decade. Incidence was generally higher among women, with a similar jump in incidence from 40s to 50s among women, whereas men showed a more gradual rate increase with age. Regionally, arthroplasty was highest in the northeast and midwest in 2010, though it was similar across regions in 2019.

Conclusions

Although IPJ arthrodesis levels have stayed relatively stable, IPJ arthroplasty showed a general decline over the decade. Incidence of both were higher among women, and despite initial regional differences, rates became more similar by 2019.

Proximal interphalangeal surface replacement in patients with severe longitudinal joint axis deviation

We compared the 2 year outcomes after proximal interphalangeal joint surface replacement in 68 joints with severe (>15°) preoperative longitudinal axis deviation and 50 joints without (<5°) preoperative deviation. Patients in both groups had a mean preoperative brief Michigan Hand Outcomes Questionnaire score of 47 and had similar 2 year scores of 72 (95% CI 68-77) (severe deviation) and 70 (95% CI 65-76) (no deviation). Pain, proximal interphalangeal joint range of motion, grip strength and complications did not differ between the groups at 2 years. Ninety per cent of the severely deviated joints had a deviation of less than 15° at follow-up. The revision rates were 5.9% and 1.8% for deviated and non-deviated joints, respectively. We recommend a surface replacing implant to correct severe preoperative axis deviations of the proximal interphalangeal joint, but the risk of revision surgery needs to be considered.Level of evidence: IV.

Prosthetic arthroplasty of the proximal interphalangeal joint using a surface replacing implant (CapFlex-PIP): 3-year outcomes

Level of evidence: IV.

Proximal Interphalangeal Joint Arthroplasty Using a Silicone Implant: A Comparison Between Integra and NeuFlex in 72 Cases

BACKGROUND

Osteoarthritis of the hand can lead to pain, stiffness, and deformation, and thus to functional disability. The purpose of this study was to compare short-term clinical outcomes of 2 silicone proximal interphalangeal (PIP) joint implants, NeuFlex and Integra, in patients with primary osteoarthritis.

METHODS

We included 72 PIP joints, of which 40 were replaced by a NeuFlex implant and 32 by an Integra implant. The average follow-up was 12 months for the Integra group and 16 months for the NeuFlex group.

RESULTS

There was no change in active flexion preoperatively and postoperatively. Extension lag and Disabilities of the Arm, Shoulder, and Hand score decreased substantially in both groups, whereas grip strength and Patient-Specific Functional Scale (PSFS) score increased. All patients were satisfied. Between groups, there was a significant difference in the PSFS score, in favor of the Integra group.

CONCLUSIONS

Both implants have excellent results, but more research is needed with more patients to prevent bias and to determine the long-term outcome of these implants.

Global mapping of institutional and hospital-based (Level II-IV) arthroplasty registries: a scoping review

PURPOSE

Four joint arthroplasty registries (JARs) levels exist based on the recorded data type. Level I JARs are national registries that record primary data. Hospital or institutional JARs (Level II-IV) document further data (patient-reported outcomes, demographic, radiographic). A worldwide list of Level II-IV JARs must be created to effectively assess and categorize these data.

METHODS

Our study is a systematic scoping review that followed the PRISMA guidelines and included 648 studies. Based on their publications, the study aimed to map the existing Level II-IV JARs worldwide. The secondary aim was to record their lifetime, publications' number and frequency and recognise differences with national JARs.

RESULTS

One hundred five Level II-IV JARs were identified. Forty-eight hospital-based, 45 institutional, and 12 regional JARs. Fifty JARs were found in America, 39 in Europe, nine in Asia, six in Oceania and one in Africa. They have published 485 cohorts, 91 case-series, 49 case-control, nine cross-sectional studies, eight registry protocols and six randomized trials. Most cohort studies were retrospective. Twenty-three per cent of papers studied patient-reported outcomes, 21.45% surgical complications, 13.73% postoperative clinical and 5.25% radiographic outcomes, and 11.88% were survival analyses. Forty-four JARs have published only one paper. Level I JARs primarily publish implant revision risk annual reports, while Level IV JARs collect comprehensive data to conduct retrospective cohort studies.

CONCLUSIONS

This is the first study mapping all Level II-IV JARs worldwide. Most JARs are found in Europe and America, reporting on retrospective cohorts, but only a few report on studies systematically.

Vascularized Composite Allograft Versus Prosthetic for Reconstruction After Facial and Hand Trauma: Comparing Cost, Complications, and Long-term Outcome

ABSTRACT

In the past decade, vascularized composite allotransplantation (VCA) has become clinical reality for reconstruction after face and hand trauma. It offers patients the unique opportunity to regain form and function in a way that had only been achieved with traditional reconstruction or with the use of prostheses. On the other hand, prostheses for facial and hand reconstruction have continued to evolve over the years and, in many cases, represent the primary option for patients after hand and face trauma. We compared the cost, associated complications, and long-term outcomes of VCA with prostheses for reconstruction of the face and hand/upper extremity. Ultimately, VCA and prostheses represent 2 different reconstructive options with distinct benefit profiles and associated limitations and should ideally not be perceived as competing choices. Our work adds a valuable component to the general framework guiding the decision to offer VCA or prostheses for reconstruction after face and upper extremity trauma.

Biomechanics of the proximal interphalangeal joint after total joint replacement

Introduction Small joints arthroplasty of the hand including the proximal interphalangeal joint (PIPJ) is associated with the need to create anatomically adapted structures using optimal materials. Introduction of a new medical device requires comprehensive preclinical testing.

The objective was to determine a range of loads allowed for the proximal interphalangeal joint after arthroplasty through analyzing the biomechanics to prevent critical conditions and complications.

Methods A full-ceramic non-constrained anatomically adapted proximal interphalangeal joint implant was developed between 2016 and 2021 using an integrated approach with preclinical trials and a clinical study of 42 patients (25 males, 17 females) with PIPJ arthritis. A digital endoprosthesis was created with 3D-modelling. Critical conditions for the digital model imitating typical joint movements were explored with the use of finite element method and the findings to be employed in clinical practice.

Results A stable biomechanical construct was intact with loads of 5 kilograms and a motion ranging from 0 to 60 degrees, with loads of 20 kilograms and a motion ranging between 0 and 30 degrees. Cortical bone could sustain loads up to 20 kilograms with a motion ranging between 0 and 60 degrees. Discussion Load capacity of the implant was explored considering the strength of bone tissue and zirconium ceramics as a material. The study set a vector for the development of the optimal mode of motor activity early after surgery and indicated the optimal range of motion to be applied after PIPJ arthroplasty.

Conclusion The load up to 5 kg was optimal for the patient to be applied early after surgery with the range of flexion measuring less that 90°. The patient could use a load of 5 to 20 kg with flexion in the proximal interphalangeal joint measuring less than 30°. Endoprosthetic components were likely to get dislocated with a load of 20 kg and flexion angle of greater than 30°. Periprosthetic fracture could occur with flexion angle of greater than 60°.

Prosthesis Options for Proximal Interphalangeal Joint Arthroplasty in Osteoarthritis: A Systematic Review and Meta-Analysis

Background: Literature investigating the long-term outcomes of prosthesis options for proximal interphalangeal (PIP) joint arthroplasty is scarce, with most reports combining indications and underlying pathologies in analyses. In this study, we aim to compare silicone, pyrocarbon and metal prostheses in PIP joint arthroplasty for primary degenerative osteoarthritis (OA). Methods: A review of scientific literature published between 1990 and 2021 was conducted. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Relevant studies were screened and the appropriate data was extracted. An evaluation of clinical outcomes (range of motion [ROM] and pain), complications (reoperation) and survival rates for each prosthesis was performed. Results: Twelve studies were included for analysis with a total of 412 PIP joints. ROM was 66.6°, 55.8° and 46.4° for metal, silicone and pyrocarbon implants, respectively. Silicone implants had the best pain score on the visual analogue scale (1.2) followed by the pyrocarbon (2.6) and metal (3.9) groups. Complication rates were lowest in silicone implants (11.3%) compared to 18.5% in pyrocarbon and 22.4% in metal prostheses. Survival did not differ significantly amongst the three groups. Conclusions: Our findings suggest that for patients with primary degenerative OA, PIP joint arthroplasty using a silicone prosthesis can provide greater pain relief with lower complication rates compared to other implant options. Level of Evidence: Level III (Therapeutic).

Proximal Interphalangeal Joint Arthroplasty Using the Wide-Awake Local Anesthesia No Tourniquet Technique

BACKGROUND

Proximal interphalangeal joint (PIPJ) osteoarthritis is a common condition that results in pain, stiffness, and loss of function in the affected hand. Proximal interphalangeal joint arthroplasty is an effective treatment option when conservative methods have failed. The wide-awake local anesthesia no tourniquet (WALANT) technique to perform surgery carries advantages such as lack of tourniquet discomfort, reduces the staffing and costs associated with anesthesia and sedation, and allows faster recovery. We aimed to determine whether the WALANT technique was safe and effective in the context of PIPJ arthroplasty.

METHODS

Patients were enrolled retrospectively from January 2015 to October 2020 by examining operating theater records and surgeon logbooks. Electronic patient records were examined to obtain patient data. Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaires and Visual Analog Scale (VAS) for pain were sent by post to patients-with a separate DASH and VAS for each digit operated on.

RESULTS

Twenty-nine PIPJ arthroplasties were carried out using WALANT technique by 3 different surgeons all using the dorsal approach. All cases were successfully carried out as day-case procedures. There was a significant correlation with increasing VAS and increasing DASH score. Proximal interphalangeal joint arthroplasty improved range of motion from 28.9 ± 5.5° to 79.4 ± 13.3° (P < .0001). Two cases developed complications related to surgery.

CONCLUSIONS

Our study is the first to report the use of WALANT to perform PIPJ arthroplasty, and shows comparable results with traditional methods. Larger, multicenter prospective trials are required to determine the efficacy of this technique and to quantify its economical benefit.

Korrektur von Fingerdeformitäten

Deformitäten der Langfinger sind neben „Rheumaknoten“ die auffälligsten Veränderungen einer bestehenden Rheumatoiden Arthritis. Die Therapie beinhaltet neben der medikamentösen Einstellung der Patienten konservative Maßnahmen, in deren Mittelpunkt die Ergotherapie steht. Neben konservativen und interventionellen Versorgungen sollte die Synovialektomie zu einem frühen Zeitpunkt erwogen werden, um die Gelenke langfristig zu schützen. Bei fortgeschrittenen Deformitäten müssen periartikuläre Strukturen in der Operation adressiert werden, um Funktionsdefizite so gering wie möglich zu halten. Gleichzeitig ist auf Grund der Dynamik der Grunderkrankung immer mit einer Progredienz und erneuten Operationen zu rechnen. Eine einzelne für ein Gelenk spezifische operative Maßnahme existiert nicht, vielmehr gilt es die verschiedenen Möglichkeiten und erforderliche Alternativen in der Planung zu berücksichtigen, um diese in der Operation entsprechend dem Ziel durchführen zu können.

Proximal interphalangeal joint prosthetic arthroplasty

Surgical treatment of the painful proximal interphalangeal (PIP) joint has evolved considerably over the past century. If arthrodesis has long been the gold standard and remains so for some, prosthesis would meet patient demand: mobility and indolence. Faced with a demanding patient, the surgeon must decide the indication, the type of prosthesis, the approach, the post-operative follow-up, etc. The history of the development of PIP prostheses demonstrates the complexity of the treatment of the destroyed PIP: appearance of prostheses, evolution and sometimes disappearance from the market for commercial reasons or related to complications. The main objective of this conference is to identify the main indications for prosthetic arthroplasties and to describe the various prostheses available on the market.